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Clinician's Digest

By Garry Cooper

Debunking the Vaccine–Autism Link?

On February 28, 1998, a small study of 12 children published in the British medical journal Lancet suggested a link between autism and the mumps-measles-rubella vaccine (MMR). The study, led by gastrointestinal surgeon Andrew Wakefield, confirmed many parents' long-standing suspicions that the vaccine had triggered autism in their children. Since then, many parents have refused the vaccinations. In 2008, for the first time in 14 years, measles was declared endemic in England, and the Centers for Disease Control reported that the first six months of 2008 saw the highest number of measles cases in the United States since 1996.

But subsequent studies by other researchers have failed to support Wakefield's contention, and troubling facts about his study have been brought to light by journalist Brian Deer. Two years prior to his study's publication, Wakefield was hired as a consultant by attorneys filing a suit against the MMR—a fact he failed to disclose—and some of the children in his study were litigants against the MMR manufacturers. Wakefield also was involved in a project to develop and market an alternative vaccine. Concerned about the wide-reaching effects of the study, its lack of replication, and the possible financial conflicts of interest, Royal Free Hospital, where Wakefield was the director of research and had conducted his study, asked him to do a larger study, offering to underwrite the cost. Wakefield refused, was asked to resign from his position, and subsequently stripped of his British medical license.

In February 2010, a decade after the study's publication, amid further allegations that the study had been misleading in significant ways, Lancet retracted the article. This past January, the British Medical Journal (BMJ) ran a three-part series by Deer, who claimed that several of the study's children had had conditions suggesting autism before they'd been vaccinated, and that some of the children's postvaccination symptoms may have been purposely exaggerated by Wakefield. Denying all allegations of fraud, Wakefield is demanding that BMJ retract Deer's articles and threatening legal action.

Despite the scandal surrounding Wakefield, many remain skeptical about vaccinations. A Harris/HealthDay poll taken just after the BMJ revelations indicates that nearly half of Americans suspect an MMR-autism link. While that connection remains unconfirmed, links between immune system dysregulation and autism, and between gastrointestinal disorders and autism have been firmly established. Those who support the MMR-autism link argue that vaccines overactivate immune systems, triggering dysregulation, gastrointestinal difficulties, and autism. They note that about 80 percent of our immune system resides in the gastrointestinal track.

For parents who suspect that the vaccine was the cause of their children's autism, Wakefield continues to be a spokesperson for their frustration, powerlessness, and outrage, says Northwestern University psychologist Alexandra Solomon, who wrote about her experience as a parent of an autistic child in the July 2009 Networker. With much of the media now declaring the question of an MMR-autism link settled, says Solomon, the money flow and enthusiasm for studies going counter to that position are likely to be cut off. Still, questions remain. Might vaccines trigger autism only in children who have a genetic susceptibility to the disorder? No one has yet run a controlled study on the autism rates between vaccinated and unvaccinated children.

The best advice about MMR, Solomon says, is to talk with your doctor about delaying and/or splitting up the vaccine into measles, mumps, and rubella, especially if there's a family history of autoimmune problems, and to seek the counsel of a physician who's followed the actual research, instead of just the media reports.